One-year outcomes of inhaled controller therapies added to systemic corticosteroids after asthma-related hospital discharge

Sadatsafavi, Mohsen; Lynd, Larry D.; Vera, Mary A. De; Zafarí, Zafar

doi:10.1016/j.rmed.2014.12.014

Cited by 10 publications

(6 citation statements)

References 30 publications

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“…Other recent studies of hospital readmissions have been limited to patients on systemic corticosteroids [ 9 ], have examined readmissions up to only 30 days [ 11 , 12 , 24 ], were much smaller [ 24 ], and/or were conducted at a single institution [ 25 , 26 ]. None of these studies, nor others examining readmissions after 30 days [ 27 – 29 ], examined the association of hospital readmissions with blood eosinophil count.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who are admitted to hospital for asthma-related reasons, such as a severe exacerbation, may be at risk of short-term readmission to hospital. For example, some patients with persistent airways inflammation are at risk of readmission after discharge despite treatment with corticosteroids [ 9 , 10 ]. Predictors of readmission are important to identify as this information could be used to improve in-hospital and post-hospitalization patient management to minimize subsequent readmissions.…”

Section: Introductionmentioning

confidence: 99%

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Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

et al. 2018

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BackgroundRecent studies have demonstrated an association between high blood eosinophil counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood eosinophil count documented before the first hospitalization.MethodsThis historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood eosinophil count within 1 baseline year before admission. We analyzed the association between high blood eosinophil count (≥0.35x109 cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection.ResultsWe identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood eosinophil count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood eosinophil count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997).ConclusionsA high blood eosinophil count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood eosinophil count require careful follow-up, with treatment optimization, after discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

et al. 2018

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“…Adherence is not a dichotomous measurement in asthma, and levels of adherence fluctuate greatly (12,15). In general, adherence to long-term asthma treatment is poor and varies according to disease severity (19,20). Adherence to asthma medication can fluctuate according to seasons, with greater adherence in the spring and fall, reflecting the presence of seasonal allergies and viral infections.…”

Section: The Burden Associated With Nonadherence To Asthma Medicationmentioning

confidence: 99%

The burden of nonadherence among adults with asthma: a role for shared decision‐making

Pollard

Bansback

FitzGerld

et al. 2017

Allergy

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To cite this article: Pollard S, Bansback N, FitzGerld JM, Bryan S. The burden of nonadherence among adults with asthma: a role for shared decision-making. AbstractA shared approach to decision-making framework has been suggested for chronic disease management especially where multiple treatment options exist. Shared decision-making (SDM) requires that both physician and patients are actively engaged in the decision-making process, including information exchange; expressing treatment preferences; as well as agreement over the final treatment decision. Although SDM appears well supported by patients, practitioners and policymakers alike, the current challenge is to determine how best to make SDM a reality in everyday clinical practice. Within the context of asthma, adherence rates are poor and are linked to outcomes such as reduced asthma control, increased symptoms, healthcare expenditures, and lower patient quality of life. It has been suggested that SDM can improve treatment adherence and that ignoring patients' personal goals and preferences may result in reduced rates of adherence. Furthermore, understanding predictors of poor treatment adherence is a necessary step toward developing effective strategies to improve the patient-reported and clinically important outcomes. Here, we describe why a shared approach to treatment decision-making for asthma has the potential to be an effective tool for improving adherence, with associated clinical and patient-related outcomes. In addition, we explore insights into the reasons why SDM has not been implemented into routine clinical practice.

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“…candidiasis, tuberculosis). When elderly patients are discharged from hospital, adherence to treatment abruptly ceases and a flare-up of symptoms after discontinuation of systemic steroids is considered a bad prognostic sign and indication of greater severity of asthma [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly

et al. 2015

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The prevalence of asthma in the most advanced ages is similar to that of younger ages. However, the concept that older individuals may suffer from allergic asthma has been largely denied in the past, and a common belief attributes to asthma the definition of “rare” disease. Indeed, asthma in the elderly is often underdiagnosed or diagnosed as COPD, thus leading to undertreatment of improper treatment. This is also due to the heterogeneity of clinical and functional presentations of geriatric asthma, including the partial loss of reversibility and the lower occurrence of the allergic component in this age range. The older asthmatic patients are also characterized the coexistence of comorbid conditions that, in conjunction with age-associated structural and functional changes of the lung, may contribute to complicate the management of asthma. The current review addresses the main issues related to the management of allergic asthma in the geriatric age. In particular, the paper aims at revising current pharmacological and non pharmacological treatments for allergic asthmatics of advanced ages, primarily focusing on their safety and efficacy, although most behaviors are an arbitrary extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. Experimental studies and real life observations specifically testing the efficacy and safety of therapeutic approaches in allergic asthma in the elderly are urgently needed.

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One-year outcomes of inhaled controller therapies added to systemic corticosteroids after asthma-related hospital discharge

Cited by 10 publications

References 30 publications

Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study

The burden of nonadherence among adults with asthma: a role for shared decision‐making

Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly

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